For natural/artificial pregnancy with IUI atleast one patent tube is a pre-requisite as egg and sperm fertilize in the tube . After 5 days blastocyst enters the uterine cavity at 150 cell stage and implants .
Bilateral tubal block necessitates the need to rule out genital tuberculosis which is treated with 6 to 9 month of AKT under physicians supervision following which IVF/ICSI can be done. Sometimes terumo guide wire under laparo hystero control can be use to clear the debris . Fallopian tube re canalization increases the chance of spontaneous conception by 30% to 50% . HSD is use to rule out hydrosalpinx. Hydrosalpinx more than 2 cm thick is best removed prior to IVF as it hampers implantation . When hydrosalpinx is complicated with adhesions cautery , ligasure or harmonic scalpel can be used . clipping at the junction of fallopian tube and uterus is a another alternative . Doing the above improves the pregnancy rate by 50%.